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目的:探讨凶险型前置胎盘并胎盘植入手术切口的选择、胎盘植入的诊断、减少手术出血及降低子宫切除率的方法。方法:总结分析2008年1月～2012年10月佛山市妇幼保健院收治的53例凶险型前置胎盘临床资料。结果:53例凶险型前置胎盘并胎盘植入20例,发生率37.7%;其中穿透性植入8例,发生率15.1%。彩色多普勒术前超声诊断胎盘植入11例,诊断率55.0%。当有胎盘植入时膀胱镜下观察膀胱黏膜血管明显增生扩张。结论:选择子宫阿氏切口剖宫产术结合子宫动脉上行支结扎、子宫B-Lynch缝合术等止血方法有效地减少了术中出血,降低了子宫切除率。
Objective: To explore the selection of dangerous placenta previa and placenta accreta incision, the diagnosis of placenta accreta, surgical bleeding and the method of reducing the rate of hysterectomy. Methods: The clinical data of 53 cases of dangerous placenta previa placenta admitted to Foshan Maternal and Child Health Hospital from January 2008 to October 2012 were summarized and analyzed. Results: Fifty-three cases of dangerous placenta previa and placenta accreta were implanted in 20 cases, the incidence rate was 37.7%. Among them, penetrating implantation was performed in 8 cases, the incidence rate was 15.1%. Color Doppler ultrasound diagnosis of placenta accreta in 11 cases, the diagnosis rate was 55.0%. When placenta accreta bladder cystoscopy observed vascular hyperplasia and expansion. CONCLUSIONS: Choosing uterine aces incision cesarean section combined with uterine artery ligation and uterus B-Lynch suture and other hemostasis methods effectively reduce the intraoperative bleeding and reduce the hysterectomy rate.